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The PREgnancy Care Integrating Translational Science, Everywhere (PRECISE)-DYAD Study is a prospective observational cohort designed to investigate health outcomes among mother-child pairs (dyads) over the first 3 years of life in two contexts from sub-Saharan Africa. The primary objective of the study was to explore the effects of selected placenta-related complications, such as pregnancy hypertension, fetal growth restriction and preterm birth, on (1) Child health and development, and (2) Women’s health and well-being, including outcomes after stillbirth.
The PRECISE-DYAD Study enrolled women (and their children) originally recruited into the PRECISE pregnancy cohort study in The Gambia and Kenya between July 2021 and April 2024. Participants were seen at 6 weeks to 6 months, 12 months, 24 months and 36 months postpartum. Clinical and health data, including anthropometry and diet, were collected for both mothers and children. Mother assessment included a cardiology assessment and collection of data about symptoms of COVID-19 infection. In a subset of participants, mothers were asked about their mental health, their healthcare costs during and after pregnancy, and experiences of care during labour and childbirth/delivery. Additionally, a personal environmental exposure assessment was performed for a subset of the cohort by collecting air and water quality data alongside geographical, demographic and behavioural factors. Child development was assessed using neurodevelopmental assessments, home environment evaluation and quality of life measures. Biological samples were collected from mothers and children, processed promptly and biobanked locally. Sample data were entered into an OpenSpecimen database and linked to each individual, as well as to their corresponding social determinants and clinical data.
A total of 2980 women and 2909 children completed at least one PRECISE-DYAD Study visit. The biorepository contains 108 897 biological samples from mothers and children. Baseline descriptive analysis of the cohort is reported here.
Analysis of data and samples will include biomarker studies, social determinants of health and epidemiological investigations. These analyses will explore how placenta-related complications and environmental exposures, such as nutrition and air quality, interact to shape maternal health, mental well-being, subsequent pregnancies and mother-child interaction, as well as child growth and neurodevelopment through early childhood. Additional work will examine the biological pathways linking these exposures to outcomes and the impacts of caring for children with moderate-to-severe disabilities on maternal well-being. Findings will be disseminated through scientific publications, conference presentations, engagement with local stakeholders and continued community outreach.
To explore emergency department triage nurses' scope of practice and activities related to their triage role and management of patients located in emergency department waiting areas.
Exploratory, descriptive, observational study using naturalistic decision making.
Data were collected using semi-structured non-participant observation: researchers recorded their observations using a lapel microphone and recorder from 8 January to 7 May 2025. Fifteen triage nurses from three emergency departments in Melbourne, Australia were observed for 2 to 2.5 h each. Audio-recordings were transcribed verbatim and analysed using deductive content analysis. The HIRAID emergency nursing framework (History including Infection risk, Red flags, Assessment, Interventions, Diagnostics, reassessment and communication) was used as the coding frame.
Participants had a median of 10 (interquartile range 7.5–21) years nursing and 5 (interquartile range 3.2–13) years triage experience. During a total of 33 observation hours, there were 303 interactions, including 237 interactions with 169 different patients; the remainder were with carers or other clinicians. In total, 1183 tasks were coded ranging from 12 to 128 tasks per triage nurse. The most common tasks were: taking a history (n = 475); post-triage communication with patients, carers and other clinicians (n = 288); patient assessment including vital signs and focussed assessments (n = 165); and interventions including medications and psychological care (n = 134). All elements of taking a history, identifying red flags and assessment were more common during the triage process, with few instances during post-triage care. Interventions (medication administration, psychological care), diagnostics (pathology, imaging, urinalysis) and communication with patients, carers and other clinicians occurred during both triage and post-triage care.
Triage nurse practice is complex, multifaceted and extends beyond triage category allocation.
The traditional perspective that triage and post-triage care are linear and clearly divided is not fit for purpose in contemporary triage practice.
The scope of triage nurses' practice both in the context of triage of incoming patients and care of patients in ED waiting areas is poorly understood. The role of triage nurses extends far beyond rapid assessment and triage category allocation and triage nurses use a breadth of expertise and skills to maintain safety, promote comfort and expedite emergency care for patients in ED waiting areas. History, red flags and assessment were more likely during the triage process than post-triage, but interventions, diagnostics and communication spanned both triage and post-triage care. Future triage and waiting area models of care and educational preparation of triage nurses should be co-designed with triage nurses and consumers, so they reflect care as delivered rather than care as imagined.
Consolidated criteria for reporting qualitative research (COREQ).
No patient or public contribution.
Large-for-gestational-age (LGA) and macrosomic births pose significant maternal and neonatal health risks, particularly in low- and middle-income countries (LMICs), where access to care are often limited. Despite well-established associations between LGA, macrosomia, and various risk factors, the relative contributions of these factors remain underexplored in LMICs. This study aims to identify risks factors for LGA and macrosomia in LMICs, with an emphasis on modifiable ones, and quantify their population attributable fractions (PAFs).
A systematic review will be conducted across the following databases: MEDLINE, Scopus and ProQuest Central and regional databases (Africa Index Medicus, Index Medicus for South Asia and Latin America and Caribbean literature of health sciences). Eligible studies will include observational studies, reviews and interventional research conducted between 2000 and 2025 that report on prevalence or association of risk factors for large-for-gestational-age (LGA) and/or macrosomia births in low- and middle-income countries (LMICs). Data extraction will encompass study characteristics, prevalence/incidence estimates, risk factor distributions and measures of association. Quality assessment will be performed by two independent reviewers using the Newcastle-Ottawa Scale for observational cohort, case–control and cross-sectional studies. While Cochrane Risk of Bias Tool will be used for randomised controlled trials and a Measurement Tool to Assess Quality of Systematic Reviews 2 (AMSTAR-2) for systematic reviews and meta-analyses. Meta-analyses using a random-effects model, which accounts for population heterogeneity, will synthesise risk estimates for factors examined in three or more studies from LMICs, up-to-date meta-analysis including all relevant studies identified through our search. Population attributable fractions for individual and combined risk factors will be calculated.
This systematic review will use only previously published information. Ethical approval is therefore not required. The results will be submitted for publication in a peer-reviewed journal and the findings will be presented at international conferences to engage relevant stakeholders including policymakers and public health organisations in LMICs with the aim of informing the development of targeted interventions to reduce the burden of LGA and macrosomia births in the region.
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